JUN 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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villages with decreasing water sources, and melting tundras. Dr. Demain pointed to pollen seasons affecting his patients earlier, with symptoms staying around longer nowadays. Dr. Demain praises the climate change and allergy research under way now in the U.S. by clinicians like Dr. Bielory. "The vast majority of research has been out of Europe, so it's nice to see more funding for this in the United States," he said. Practical implications for your practice The climate changes point to an increasing role for ophthalmologists as well as allergists to properly diagnose and treat ocular allergies. First, ophthalmologists and allergists may start to see themselves as educators about climate change and its effect on allergies, said Dr. Demain. "As the allergy seasons get longer, physicians will be the voice of that to the public," he said. "Allergists in particular have an obligation to put a face and voice to this." Dr. Demain said the connection between increasing allergies and climate change takes the politics out of the issue and makes it more relevant for the average patient. The increasingly long allergy seasons should keep clinicians more aware of ocular allergies as a cause for any suspicious related symptoms, said Dr. Demain. That includes dry eye-related symptoms, as ocular allergies and dry eye often occur simultaneously, Dr. Bielory said. Because of increasing allergies, eyecare specialists should consider referring patients to allergists more frequently for evaluation, Dr. Bielory said. He was co-author of a poster at this year's Association for Research in Vision and Ophthalmology annual meeting in Seattle that reported eyecare specialists are not referring allergy patients as often as they should be. "If a patient has progressive allergy issues over two or three years, then the idea of immunotherapy should be considered. When properly performed, it will make people more tolerant to the allergen. They can be exposed to 10 to 100 times more of the allergen, reduce their medication use, and be tolerant to exposure," he said. According to the preliminary report, eyecare specialists noted that almost 100% of patients started on immunotherapy had a marked decrease in medication use for their allergies. In addition, one other treatment option on the horizon includes sublingual immunotherapy, an approach approved in Europe that involves the placement of a target allergen under the tongue. A drawback with this approach is that it doesn't typically target multiple allergens at once like an allergy shot does, Dr. Bielory said. Another approach under investigation is the use of nucleotides, which could lessen the time and number of shots a patient would need to become immunized, Dr. Bielory explained. On the other end of the practice spectrum, the upswing in allergies should prompt allergists to work more closely with ophthalmologists in certain cases, Dr. Bielory said. For example, if a patient will use the corticosteroid loteprednol (Lotemax, Bausch + Lomb, Rochester, N.Y.) for more than 10 days, the allergist should enlist the help of the ophthalmologist to obtain baseline IOPs and to assess for any lens opacification over time, he said. EW References 1. Bielory L, Lyons K, Goldberg R. Climate change and allergic disease. Curr Allergy Asthma Rep. 2012;12:485-494. 2. Dapul-Hidalgo G, Bielory L. Climate change and allergic diseases. Ann Allergy Asthma Immunol. 2012; 109:166–172 3. Ziska LH, Gebhard DE, Frenz DA, Faulkner S, Singer BD, Straka JG. Cities as harbingers of climate change: Common ragweed, urbanization, and public health. J Allergy Clin Immunol. 2003;111:290-295. Editors' note: Dr. Bielory has financial interests with Allergan (Irvine, Calif.), Bausch + Lomb, GlaxoSmithKline (Middlesex, U.K.), Merck (Whitehouse Station, N.J.), and Sanofi (Bridgewater, N.J.). Drs. Demain and Ziska have no financial interests related to this article. Contact information Bielory: 973-912-9817, drlbielory@gmail.com Demain: 907-562-6228, jdemain@allergyalaska.com Ziska: 301-504-6639, l.ziska@ars.usda.gov

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